POS0800-HPR START WITH THE END IN MIND- EMBEDDING AN INTEGRATED SELF MANAGEMENT APPROACH WITHIN ROUTINE CLINICAL CARE FOR NEWLY DIAGNOSED PATIENTS WITH INFLAMMATORY ARTHRITIS
Authors: J. Harkess, E. Webber, R. Mclaren, A. Mackenzie, H. Bett, S. Hailwood, Y. Robertson, T. Dickson
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Long term outcomes of inflammatory arthritis patients are not only dependent on early identification of symptoms and tight control of disease, but also on the person's abilities to manage the impact of their condition. (1-2) In 2019 Fife Rheumatology Service focussed on early identification of patient's assets for self managment (SM) and those at risk of poorer outcomes with the aim of targeting supported SM resources. EULAR 2021 recommendations endorse the implementation a self management approach within routine care[3]. <h3>Objectives:</h3> 1. Implement a SM approach as part of routine clinical care. 2. Establish baseline patient characteristics data set to evaluate the effectiveness SM interventions on long term outcomes. <h3>Methods</h3> Identified priorities of the re-design were: 1. Additional investment in psychology to lead the re-design. 2. SM database. 3. SM screening and triage tool, and, a SM check list. 4. Stepped model of care including referral to patient organisations. 5. Feedback from patients, staff and patient organisations. 6. Virtual weekly patient disease and SM virtual multidisciplinary team (VMDT) clinic. 7. SM Digital App. 8. Patient Initiated Review (PIR) system for disease stable and self managing patients. <h3>Results</h3> All 8 priorities were implemented and 315 patients have been referred to the pathway since 25/08/2022. Positive feedback about the pathway and the App has been received from patients, staff and patient organisations. Six patients at 5 months post diagnosis are discussed weekly at our VMDT clinic. Of the total patients referred, 42% were male and 58% were female. The mean age was 56 years, range 16-85 years. Twenty one percent of patients at baseline had low to moderate confidence in managing their inflammatory arthrtis across the 4 subsets of <i>Emotions, Activities of daily Living (ADLS), Social Interactions</i> and <i>Symptoms</i> of the Patient-Reported Outcomes Measurement Information System-managing chronic conditions.(4) Lowest scores were found in the <i>Emotions</i> and <i>ADLs subsets.</i> Nineteen percent of patients of working age were not working. Twenty eight percent of patients had moderate to severe disability on the Modified Health Assessment Questionnaire and 54% had moderate to severe depression on the Patient Health Questionnaire-9. Forty two percent of patients fell into the deprived or most depvied categories of the Scottish Index of Multiple Deprivation. <h3>Conclusion</h3> The implementation of a self management approach as per EULAR Recommendations has been well received by key stakeholders and has helped with the early identification of patients' SM needs and highlighted those at risk of poorer outcomes. This data will act as a basis for the application of improvment methodology to assess the effectivness of future interventions and measure long term outcomes. Early indications would suggest targeting resources on improving patients' confidence in managing their mental mealth and ADLs. <h3>References</h3> [1]Gwinnutt JM et al 2020 Long-term outcomes of patients who rate symptoms of rheumatoid arthritis as 'satisfactory'. <i>Rheumatology</i>, Volume 59, Issue 8, August Pages 1853–1861, https://doi.org/10.1093/rheumatology/kez497 [2]Negrón JB et al 2022 Patient perspectives on long-term outcomes in rheumatoid arthritis. A qualitative study from the OMERACT patient outcomes in longitudinal studies working group, Seminars in Arthritis and Rheumatism,152028, ISSN 0049-0172, https://doi.org/10.1016/j.semarthrit.2022.152028 [3]Nikiphorou E et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis https://ard.bmj.com/content/80/10/1278 (Accessed: 8th January 2023) [4]Cella D et al 2007; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care.2007 May; 45 (5 Suppl 1):S3-S11. https://doi 10.1097/01.mlr.0000258615.42478.55 PMID: 17443116; PMCID: PMC2829758 <h3>Acknowledgements</h3> I would like to thank the following people. My co authors for their support of the project and editing of the abstract, Elena Nikiphorou from EULAR. and Ailsa Bosworth from NRAS, the rheumatology clinical and administrative teams including Alison McLaren, Stacey Westland and Karen McMillan, and, lastly I want to thank my patients who are a constant source of inspiration in self management. <h3>Disclosure of Interests</h3> None Declared.